Provider Demographics
NPI:1952077281
Name:MAJOCH, KELLY SANTANA
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SANTANA
Last Name:MAJOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4208
Mailing Address - Country:US
Mailing Address - Phone:201-362-6955
Mailing Address - Fax:
Practice Address - Street 1:274 GROVE ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4208
Practice Address - Country:US
Practice Address - Phone:201-362-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9061374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9061OtherDONA INTERNATIONAL